Empowering patients to become proactive with their medical bills

As health care providers are tasked with more administrative duties such as documentation, coding, and billing, the goal to minimize health care costs will continue to be extremely challenging.

In my role, I work with physicians on these challenges daily to ensure not only do the physicians get paid accurately but patients understand their benefits when they see our physicians.  Currently, I am the revenue cycle manager for the department of obstetrics and gynecology at Beth Israel Deaconess Medical Center in Boston, MA.  As a seasoned health care professional, I have 20+ years of experience in medical and surgical coding, revenue cycle operations, and billing compliance. In addition, I continue to provide independent consulting services to private practices and health care organizations.

Recently, I was waiting to be seen for a new patient appointment and had planned for the visit to take one hour. Unbeknownst to me, the majority of my visit was going to be spent on a patient down the hall that needed immediate care. After forty minutes, a physician came in to see me and initiated review of history and exam; the total time he spent with me was approximately 15 minutes. It was at this moment that I understood how a physician can suddenly be taken away from the regular flow of the clinic; it can take providers away from some key medical decision making factors and tasks such as completing an exam, revising a clinical note, or selecting appropriate codes for billing.

The following month, I received a bill and took notice of the CPT codes that were submitted. I instantly realized the level of the evaluation and management (E/M) code could not be accurate based on the time spent or the exam performed.  I immediately requested my medical note from the visit. As a medical coding specialist, I am trained to review and abstract coding from medical documentation.  After my visit, I felt very fortunate to have these skills given what level of coding I saw on my bill.

Upon review, the exam portion contained elements from the physician’s general visit template and, to my knowledge, more than half of the exam documented was never performed.  All in all, the procedure (CPT) billed was inaccurate, and I requested that the provider review the note and amend as necessary to correct the coding.

This unique opportunity and yet invaluable experience provides a teaching moment regarding the pros and cons of templates and the cut and paste issues that directly contribute to the inaccuracies of medical documentation and billing. Moreover, my case is one out of many that may fall through the cracks, which demonstrates how this may affect the total patient experience and impact revenue flow for the practice as well as ensuring the patient is paying the correct amount.

Empowering patients to become proactive with their medical bills by requesting a detailed invoice from the billing vendor or reaching out to their health care providers to further understand services performed can trigger communication pathways. This type of patient feedback can help design new ways for physician practices to ensure accuracy and can provide further insight to health care providers on how to balance the delivery of high quality care while simultaneously controlling costs.

Michelle Del Monico is a certified professional coder.

Empowering patients to become proactive with their medical bills

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

Comments are moderated before they are published. Please read the comment policy.

  • JPedersenB

    That’s a great idea. Hopefully, practices will not greet such requests with hostility when the requests come from someone without your level of expertise…

  • FriendlyJD

    I recently saw my primary care doc. In addition to the usual exam bill on my EOB, there was an additional line labeled “medical procedure,” which my insurance paid out an additional $100 for. All I did was get my allergy med refilled. No tests, no labs, nothing. In and out in 3 minutes.

    I’m not sure if it was fraud or a mistake or just something I’m missing, but frankly, my deductible has been met, and because I’m not shelling out the cash, it’s not worth a fight to me. I like my primary care doctor, and I’d worry any action would jeopardize my relationship with her. My old insurance used to give me the ICD 9 and CPT codes with all of my EOBs, and with that, it was pretty easy to double check things without first contacting the doctor. That might be an easy first step.

    That said, I do love when I get a copy of my medical records, and they have ROS that is clearly copy-pasted. 1) Because the doctor never questioned me on any of them and 2) because I have a heart defect that’s easily detected by stethoscope and could never lead to the note: “Regular rate and rhythm. No murmur, rubs, or gallops.”

  • guest

    Or, “this type of patient feedback” can encourage doctors to stop accepting insurance and move to direct-pay practices so that they don’t have to put up with harassment by a patient on top of abuse by the patient’s insurance company…

  • medicontheedge

    My knowledge is in medical equipment and supplies, as I am tasked with ordering some supplies thru our hospital purchasers, for our ED. I KNOW what the hospital PAYS for supplies, and as a patient of the same facility, know what the hospital BILLS for the same item. Appalling! Is it fraud? Laziness? Padding the bills to cover other loses? Probably a combination of all three. But this model HAS to be reformed. I have successfully challenged bills at both the hospital and my Orthopedic Doc’s office. But the average customer has no idea. Nor do they care, especially if they have no “skin in the game”, as in co-pays and deductibles.

  • Karen Ronk

    From my own and other’s experiences, I tend to believe that medical providers throw every possible code out there and see what they can get paid for. Based on what I have learned about their reimbursements, I really cannot blame them, even though it does often seem close to the line of honesty. This system is so messed up and I cannot imagine anyone being able to effect meaningful reform in our current political climate.

  • RenegadeRN

    The average patient, not even medical professionals do not have your ability to discern inaccuracies in their bill. I truly doubt the mistakes are ever made to the patient’s benefit.
    I agree with the other poster who said it is practice to throw it out there and see what they get to stick!
    Doesn’t the AMA keep this as complicated as it is, and has now become, with ICD 10?

Most Popular